EAST TENNESSEE MEDICAL AND SURGICAL DERMATOLOGY (NPI# 1356975106) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356975106 |
| Entity Type | Organization |
| Organization Name | EAST TENNESSEE MEDICAL AND SURGICAL DERMATOLOGY |
| Practice Address |
2898 Boones Creek Rd Ste 105 Johnson City TN 37615-4976 |
| Practice Telephone | 4232620112 |
| Mailing Telephone | 4232620112 |
| Mailing Fax Number | 4234336060 |
| Enumeration Date | 2020-03-02 |
| Last Update Date | 2020-07-15 |
| Authorized Official Name | STUART S LEICHT (PHYSICIAN) |
| Authorized Official Telephone | 4232620112 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM2500X |
Clinic/Center Specialization: Medical Specialty |
Ambulatory Health Care Facilities |
| Street Address |
2898 BOONES CREEK RD STE 105 |
| City | JOHNSON CITY |
| State | TN |
| Zip Code | 37615-4976 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013902907 | Stuart S Leicht | Dermatology | 2898 Boones Creek Rd Ste 105, Johnson City, TN 37615-4976 | 2005-09-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568962983 | Clayton Kilgore | Pharmacist | 208 Suncrest St Unit 1, Gray, TN 37615 | 2018-02-13 |
| 1346648268 | Jesse Mullins | Pharmacist | 121 Boone Ridge Dr, Suite 1006, Johnson City, TN 37615 | 2014-12-09 |
| 1750650875 | Medical Education Assistance Corporation | Pediatrics | 252 Sam Jenkins Rd, Attn: Dr. H. Patrick Stern, Gray, TN 37615 | 2011-12-19 |
| 1700018603 | Anna Lynne Deal | Nurse Practitioner | 119 Boone Ridge Dr., Ste. 201, Johnson City, TN 37615 | 2009-08-11 |
| 1285876631 | Leigh A Furman | Occupational Therapist | 253 Wiltshire Dr., Gray, TN 37615 | 2009-04-01 |
| 1811098908 | Fay Lynn Bembry | Nurse Practitioner | 119 Boone Ridge Drive Ste. 201, Johnson City, TN 37615 | 2006-09-25 |
| 1871528976 | Boones Creek Medical Pllc | Family Medicine | 2685 Boones Creek Road, Suite 104, Johnson City, TN 37615 | 2006-07-11 |
| 1568402048 | Joseph Vincent Pinyard Jr. | Family Medicine | 880 Boones Station Rd, Johnson City, TN 37615 | 2006-06-07 |
| 1548223084 | Pitchar Theerathorn | Internal Medicine | 119 Boone Ridge Drive, Suite 201, Johnson City, TN 37615 | 2006-04-07 |
| 1194717157 | Susan Kay Pennypacker | Nurse Practitioner | 140 Old Gray Station Rd, Suite 200, Gray, TN 37615 | 2005-08-16 |
| Find all providers in zip 37615 | ||||
| Taxonomy Code | 261QM2500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Medical Specialty |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043451578 | Ray W. Mettetal Jr., M.d. Inc. | Clinic/Center | 329 Wesley St Ste 4, Johnson City, TN 37601-1721 | 2009-03-12 |
| 1396842506 | Tier Ent Associates, PC | Clinic/Center | 15 Riverside Dr, Johnson City, NY 13790-2742 | 2006-09-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174152011 | Better Life Medical PC | Clinic/Center | 2103 Forest Dr Ste 6, Gray, TN 37615-8422 | 2020-04-03 |
| 1194362889 | Christal Joy Gammage | Clinic/Center | 435 S Front St Apt 101, Memphis, TN 38103-6403 | 2019-12-02 |
| 1609388438 | East Tennessee Children's Hospital Association, Inc. | Clinic/Center | 1060 Peerless Xing Nw Ste 100, Cleveland, TN 37312-3785 | 2017-11-02 |
| 1376095596 | Dr. Andrea's Medical & Weight Loss Clinic, Pllc | Clinic/Center | 8317 Cordova Rd, Suite 201, Cordova, TN 38016-2088 | 2016-11-04 |
| 1316304629 | Deep River Wellness Center | Clinic/Center | 314 Knox Rd, Knoxville, TN 37918-2316 | 2016-01-19 |
| 1417342973 | Sleep Disorders of Tennessee | Clinic/Center | 254 Ren Mar Dr Ste 200, Pleasant View, TN 37146-3723 | 2015-04-01 |
| 1891069555 | Hrc Medical Centers Inc | Clinic/Center | 301 14th Ave N, Nashville, TN 37203-3416 | 2012-02-28 |
| 1801177449 | Mcminn Ortopaedic Clinic, PC | Clinic/Center | 719 Cook Dr Ste 110, Athens, TN 37303-3495 | 2011-09-08 |
| 1104105873 | Swan Urogynecology, PC | Clinic/Center | 329 21st Avenue North, Suite 1, Nashville, TN 37203-1857 | 2011-08-11 |
| 1023304938 | William J Deaton | Clinic/Center | 1462 Wolf Park Rd, Germantown, TN 38138-2354 | 2011-06-20 |
| Find all providers with the same taxonomy | ||||
| City | JOHNSON CITY |
| Zip Code | 37615 |
Please comment or provide details below to improve the information on EAST TENNESSEE MEDICAL AND SURGICAL DERMATOLOGY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.